What is the recommended dose of ibuprofen (Nonsteroidal Anti-Inflammatory Drug (NSAID)) for mild to moderate pain?

Ibuprofen Dosing for Mild to Moderate Pain

For mild to moderate pain, give ibuprofen 400 mg orally every 4-6 hours as needed, not exceeding 2400 mg per day. 1, 2

Standard Dosing Regimen

• The FDA-approved dose for mild to moderate pain is 400 mg every 4-6 hours 2
• This 400 mg dose has been demonstrated in controlled analgesic trials to be the optimal single dose—higher doses were no more effective 2
• The maximum daily dose should not exceed 2400 mg (six 400 mg doses) for acute pain conditions 1, 3, 2
• Use the lowest effective dose for the shortest duration consistent with treatment goals to minimize gastrointestinal, cardiovascular, and renal toxicity 1, 3

Evidence Supporting 400 mg Dosing

• Ibuprofen 400 mg provides superior pain relief compared to aspirin 600-900 mg, paracetamol, and is comparable to ketoprofen 25 mg in dental pain models 4
• The duration of action for 400 mg is at least 6 hours, compared to only 4-6 hours for the 200 mg dose 4
• A clear dose-response relationship exists for single doses from 50-400 mg, with 400 mg representing the peak of the efficacy curve 4
• Multiple clinical trials confirm 400 mg is as effective or more effective than aspirin, codeine, or propoxyphene for mild to moderate pain 5

Critical Safety Considerations

High-risk populations requiring dose reduction or avoidance:

• Older adults (>60 years): Start with lower doses due to increased risk of all NSAID-related adverse effects; acetaminophen may be preferred as first-line 1, 3
• Patients with cardiovascular disease: Use extreme caution and the lowest effective dose, as cardiovascular risk increases at higher doses 1
• Renal impairment: Avoid in severe renal impairment (CrCl <10 mL/min); use extreme caution in compromised fluid status 1
• Active peptic ulcer disease: This is an absolute contraindication 1
• Patients on anticoagulants: GI bleeding risk increases 5-6 times with concomitant use 3

Timing Considerations for Aspirin Users

• If the patient takes low-dose aspirin for cardioprotection, administer ibuprofen at least 30 minutes after immediate-release aspirin or at least 8 hours before aspirin to avoid interference with aspirin's antiplatelet effects 1

Common Pitfalls to Avoid

• Never combine ibuprofen with other NSAIDs—this increases risk without providing additional benefit 1
• Do not exceed 2400 mg/day for acute pain without compelling clinical justification, as the risk-benefit ratio deteriorates significantly at higher doses 3, 2
• Avoid prolonged use without reassessing benefits and risks 1
• Do not use in perioperative pain for coronary artery bypass graft surgery (absolute contraindication) 3
• If gastrointestinal complaints occur, administer with meals or milk 2

When to Consider Alternative Therapy

• If pain persists despite 400 mg dosing, consider escalating to WHO Step II analgesics (weak opioids combined with non-opioids) rather than exceeding recommended ibuprofen doses 6
• For patients with multiple contraindications, acetaminophen 1000 mg every 4-6 hours (maximum 4000 mg/day) is the preferred first-line alternative 6